Provider Demographics
NPI:1588784383
Name:KANSAS CHILDREN'S SERVICE LEAGUE
Entity type:Organization
Organization Name:KANSAS CHILDREN'S SERVICE LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHEZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-274-3100
Mailing Address - Street 1:200 SW 30TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2232
Mailing Address - Country:US
Mailing Address - Phone:785-274-3100
Mailing Address - Fax:785-274-3822
Practice Address - Street 1:200 SW 30TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2232
Practice Address - Country:US
Practice Address - Phone:785-274-3100
Practice Address - Fax:785-274-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management